Endoscopic suture tying method

Abstract

Endoscopic suture tying apparatus adapted to be grasped by the hand for use in a laparoscopic procedure with an introducer device extending into the body of a patient having a sleeve with a bore therein extending therethrough into the body of the patient. A holding sleeve is provided which is sized so that it can be introduced through the bore of the introducer device. First and second grasping devices are provided which are mounted in the holding sleeve. Each of the grasping devices is comprised of a hollow tubular member having a bore therein and a push-pull rod slidably mounted in the bore in the tubular member. The outer tubular member has proximal and distal extremities. First and second jaws are provided which are secured to the distal extremity of the tubular member. The jaws are movable between open and closed positions with respect to each other. The outer sleeve and the rod are connected to the first and second jaws whereby upon relative movement between the outer sleeve and the rod the first and second jaws are moved between said open and closed positions. Handles are secured to the proximal extremity of the outer sleeve and to the proximal extremity of the rod for causing the relative movement between the tubular and the rod.

What is claimed is: 
     
       1. A method for tying a knot in a suture, comprising providing an endoscopic suture-tying apparatus comprised of a holding sleeve having first and second grasping devices slidably mounted in the holding sleeve and having a grasper at the distal extremity thereof, providing a suture having first and second free ends, using the first grasping device to grasp the first free end, rotating the first grasping device grasping the first free end to form a plurality of helical wraps around the first grasping device, using the second grasping device to grasp the first free end of the suture retained by the first grasping device, operating the first grasping device to release the first free end from the first grasping device, using the first grasping device to grasp the second free end, moving the first grasping device to move the second free end through the helical wraps, moving the first and second grasping devices to pull on the first and second free ends to tighten the helical wraps to form at least a portion of a knot. 
     
     
       2. A method as in claim 1 together with the additional steps of grasping the first free end with the first grasping device, rotating the first grasping device to form helical wraps extending in an opposite direction from the first named helical wraps formed, manipulating the second grasping device to grasp the first free end of the suture being retained by the first grasping device, operating the first grasping device to release the first free end from the first grasping device, operating the first grasping device to grasp the second free end, moving the first grasping device to bring the second free end through the helical wraps formed in said opposite direction, moving the first and second grasping devices to pull on the first and second free ends to tighten the helical wraps extending in said opposite direction to bring them close together and to come into contact with the first named wraps to form a cinched knot.